title: Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation.
abstract: OBJECTIVE
  Although native radiocephalic arteriovenous fistula (RCAVF) is the best vascular access for hemodialysis (HD), a major obstacle to increase its use is high frequency of fistulas that fail to mature. The aim of this study was to investigate and define cut-off values of morphologic and functional vessel parameters influencing successful RCAVF maturation using ultrasound.
  
  
  METHODS
  A prospective, observational study was performed on 122 patients (66 men) who underwent primary RCAVF creation. Internal diameters of cephalic vein (CVd) and radial artery (ARd), venous distensibility (VD), resistance index (RI) and endothelial function by flow mediated dilatation (FMD) were determined by ultrasound examination before AVF placement. AVF maturation was observed by measuring blood flow (Qa) and CVd 0, 14 and 28 days after creation. Depending on the time when AVFs attained maturity (Qa ≥500 mL/min, CVd ≥5 mm), patients were divided into three groups: (i) successful maturation (after four weeks), (ii) prolonged maturation (within eight weeks) and (iii) failure to mature.
  
  
  RESULTS
  Only 11% of patients failed to achieve a mature RCAVF. Successful AVF maturation occurred in 53% of patients and prolonged maturation in 36% of patients. ROC analysis defined the limits ​​of variables relevant for RCAVF success (CVd >1.8 mm, ARd >1.6 mm, VD >0.4 mm). Female sex was associated with prolonged maturation (OR 0.35, 95% CI=0.17-0.72; P=0.005) having a significantly smaller ARd (1.83 vs. 2.01 mm, P=0.01) but better FMD (2981.5 vs. 2689.5, P=0.02) compared to men.
  
  
  CONCLUSIONS
  ARd ≤1.6 mm, CVd ≤1.8 mm and VD ≤0.4 mm are exact cut-off points, which best predict nonmaturation of RCAVF. Women need extended time for adequately matured AVF.
authors.affiliation: Clinic of Nephrology, Clinical Center of Serbia, Belgrade - Serbia.
authors.forename: Tamara K
authors.initials: TK
authors.lastname: Jemcov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D003187:Compliance; D004548:Elasticity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D034941:Upper Extremity / Q000098:blood supply*; D014655:Vascular Resistance; D014664:Vasodilation; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult